| Providence Medical Group Northern California | |
|
185 Sotoyome St Santa Rosa CA 95405-4803 | |
| (707) 303-8355 | |
| (707) 303-2035 |
| Full Name | Providence Medical Group Northern California |
|---|---|
| Speciality | Family Medicine |
| Location | 185 Sotoyome St, Santa Rosa, California |
| Authorized Official Name and Position | Bob Just (CHIEF EXECUTIVE) |
| Authorized Official Contact | 7073038355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Northern California 185 Sotoyome St Santa Rosa CA 95405-4803 Ph: (707) 303-8355 | Providence Medical Group Northern California 185 Sotoyome St Santa Rosa CA 95405-4803 Ph: (707) 303-8355 |
| NPI Number | 1265015978 |
|---|---|
| Provider Enumeration Date | 04/30/2021 |
| Last Update Date | 07/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265015978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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